Miriam Almagor

Electroejaculation before chemotherapy in adolescents and young men with cancer

OBJECTIVE To evaluate the outcome of repeated electroejaculation for obtaining semen from adolescents and young men before initiation of anticancer therapies. DESIGN Retrospective clinical study. SETTING Bikur Cholim Hospital, Jerusalem, Israel. PATIENT(S) Six young male patients (average age, 18+/-3 years) with diagnosed cancer who underwent 12 procedures of electroejaculation before chemotherapy. INTERVENTION(S) Transrectal electroejaculation. Semen was cryopreserved in small aliquots. MAIN OUTCOME MEASURE(S) Semen analysis. RESULT(S) In all patients, semen was obtained by electroejaculation. Sperm count and motility were relatively low; mean values were 16 x 10(6) (range, 0--45 x 10(6)) and 14% (range, 0--53%) respectively. CONCLUSION(S) If necessary, electroejaculation can be performed in adolescents, and sperm may be obtained by repeated treatments over a short period.

Pregnancy rates after communal growth of preimplantation human embryos in vitro

OBJECTIVE To evaluate the effect of communal growth of preimplantation human embryos on pregnancy rates in IVF-ET. DESIGN Prospective randomized study. SETTING In Vitro Fertilization Unit, Bikur Cholim Hospital, Jerusalem, Israel. PATIENTS Ninety-one women undergoing 91 cycles of IVF-ET. INTERVENTION In 42 cycles (control) embryos were grown singly, in 49 cycles (study) embryos were grown in groups until transfer. MAIN OUTCOME MEASURES Proportion of women achieving pregnancy in study and control groups. RESULTS Communal growth of embryos resulted in significantly improved pregnancy rates. Intrauterine transfer of embryos grown in groups produced 43% pregnancy rates per transfer, whereas, with embryos grown individually, 24% pregnancy rates were obtained (odds ratio = 2.4). CONCLUSIONS Our study suggests that, in IVF, the potential of preimplantation human embryos to produce pregnancy tends to increase when embryos are grown in groups.

Electroejaculation and assisted fertility in men with psychogenic anejaculation

OBJECTIVES To evaluate sperm characteristics and fertility potential in ejaculates obtained after electroejaculation in men with psychogenic anejaculation. DESIGN Retrospective clinical study. SETTING In Vitro Fertilization Unit, Bikur Cholim Hospital, Jerusalem, Israel. PATIENTS Twenty men with psychogenic anejaculation who underwent 55 sessions of electroejaculation and their spouses. INTERVENTIONS Electroejaculation, assisted reproduction technologies. MAIN OUTCOME MEASURES Semen analysis, IVF, intracytoplasmic injection (ICSI), fertilization rates, and pregnancy rates. RESULTS In all patients, sperm density and motility rates were unsatisfactory (98 +/- 127 x 10(6) with 14.6% +/- 15% motility in the antegrade portions and 42 +/- 42 x 10(6) with 9.7% +/- 15.6% motility in the retrograde samples). Intrauterine inseminations performed in eight couples did not result in a pregnancy. Four couples underwent IVF-ET treatments. Two pregnancies were achieved with overall success rates of 22% per cycle. Five couples were treated using the ICSI procedure. Although good quality embryos were transferred, none of the treatments resulted in a pregnancy. CONCLUSIONS Psychogenic failure to ejaculate may be treated by electroejaculation. However, the average motility of the sperm obtained is diminished. The combination of electroejaculation with IVF, including the ICSI procedure, should improve chances of fertilization and pregnancy in these cases.

CHANGES IN SEMEN QUALITY IN JERUSALEM BETWEEN 1990 AND 2000: A CROSS-SECTIONAL AND LONGITUDINAL STUDY

The aim of the present study was to investigate whether sperm quality has changed during the years 1990-1999 among men residing in Jerusalem, Israel, who were involved in treatment by intrauterine insemination (IUI). Both cross-sectional and longitudinal analyses were performed. A total of 2638 male partners in couples that underwent treatment by IUI participated in the cross-sectional investigation. Of them, 417 men (16%) were included in the longitudinal study. Total sperm counts and percent motility were evaluated on an annual basis to assess changes over 10 years from 1990 through 1999. A significant downward trend in sperm count and motility was demonstrated in the cross-sectional study. Sperm count decreased by 5.2×10 6 ±0.9×10 6 ( p <. 0001) each year and percent motility declined by 0.50±0.14% ( p =.0003). Similar changes were found in the longitudinal evaluation, but they were not statistically significant. These data suggest that during the last decade in Jerusalem, sperm count and motility declined significantly among men involved in infertile relationships and treated by IUI.

Nocturnal sperm emission in men with psychogenic anejaculation

OBJECTIVE To evaluate sperm characteristics and fertilization potential in sperm obtained from nocturnal emission in men with psychogenic anejaculation. DESIGN Retrospective study. SETTING In Vitro Fertilization Unit, Bikur Cholim Hospital, Jerusalem, Israel. PATIENT(S) Six men with psychogenic anejaculation. INTERVENTION(S) Nocturnal emission, electroejaculation, sperm cryopreservation, and assisted reproduction technologies. MAIN OUTCOME MEASURE(S) Semen analysis, intracytoplasmic sperm injection (ICSI), fertilization rates. RESULT(S) In four patients, the concentration and motility of sperm obtained from freeze-thawed nocturnal emission were decreased compared with sperm from electroejaculation. Fertilization rates after ICSI using the nocturnal emission sperm were relatively low (45%). One clinical pregnancy was achieved after intrauterine insemination. CONCLUSION(S) The quality of sperm from nocturnal emissions is variable, but it can be used in assisted reproduction procedures to avoid aggressive procedures such as electroejaculation or testis biopsy.

Diagnostic Laparoscopy in Primary and Secondary Infertility

Purpose:Our purpose was to compare the diagnostic efficacy of laparoscopy between primary and secondary infertility and to define a subgroup in which the positive findings are low.Methods:A retrospective review of the cases of 206 infertile women who underwent laparoscopy was conducted.Results:Eighty-two (39.8%) patients were found to have evidence of pelvic disease—20 (22.2%) with primary infertility and 62 (54.3%) with secondary infertility. The ratio of positive findings in secondary infertility was significant in comparison with the positive findings in primary infertility. In only 3 of the 20 patients with primary infertility was there no history of an abdominal operation, pelvic inflammatory disease, or an abnormal hysterosalphingography. Of the 62 women who suffered secondary infertility and had positive findings in laparoscopy, 15 had no history of suspect findings.Conclusions:The diagnostic yield of laparoscopy for primary infertility in the absence of indications of mechanical factors is low. Therefore the need for diagnostic laparoscopy in these cases should be reconsidered.

Electroejaculation in combination with intracytoplasmic sperm injection in patients with psychogenic anejaculation results in lower fertilization rates.

OBJECTIVE To evaluate the outcome of intracytoplasmic sperm injection (ICSI) with sperm obtained by electroejaculation in men with psychogenic anejaculation. DESIGN Retrospective clinical study. SETTING In Vitro Fertilization Unit, Bikur Cholim Hospital, Jerusalem, Israel. PATIENT(S) Seven men with psychogenic anejaculation who underwent 16 sessions of electroejaculation in combination with ICSI. INTERVENTION(S) Electroejaculation, ICSI. MAIN OUTCOME MEASURE(S) Semen analysis, ICSI, fertilization rates. RESULT(S) All patients had poor sperm motility. One hundred forty-seven oocytes were injected, with a fertilization rate of 27% (39/142). One ongoing pregnancy was achieved. CONCLUSION(S) Sperm obtained by electroejaculation have low motility and reduced fertilization potential. Nevertheless, ICSI should be offered to improve the possibility of successful pregnancy.

Antisperm Antibodies in Men with Psychogenic Anejaculation

Antisperm autoantibodies were determined in 16 men suffering from psychogenic anejaculation who underwent assisted reproduction treatments. Blood and semen samples were collected after transrectal electroejaculation and antisperm antibodies in serum and on the surface of motile spermatozoa were measured using the direct and indirect immunobead binding test. Five men (31%) were found positive for antisperm antibodies. The majority of antibodies were directed against the sperm heads. Surface antibodies were mainly IgA isotype whereas serum antibodies were IgG isotype. These results suggest that psychogenic anejaculation might be associated with increased incidence of antisperm autoimmunity.

Simultaneous swim-up/swim-down of sperm in assisted reproduction procedures

PurposeHigh-quality motile human spermatozoa were obtained following treatment of semen by simultaneous swim-up into medium and swim-down into an isotonic 40% Percoll solution.ResultsThis procedure was significantly better than the swim-up method and comparable to discontinuous Percoll gradient centrifugation. Recovery rates of motile sperm were 35% for swim-up, 65% for Percoll gradient centrifugation, and 73% for swim-up/swim-down.ConclusionThe swim-down sperm was inferior to the swim-up sperm in its upward migration capacity but superior in morphology. Spermatozoa obtained by the swim-up/swim-down procedure demonstrated fertilizing ability in IVF, and clinical pregnancies were established. The simultaneous swim-up/swim-down procedure offers an alternative efficient method of simple separation of high-quality motile sperm for various assisted reproduction techniques.

Decreased levels of fibrinogen in very high parity women

OBJECTIVES To evaluate coagulation parameters in healthy pregnant grand grand multiparous women. STUDY DESIGN Prothrombin time (PT), activated partial thromboplastin time (PTT), fibrinogen, D-dimer, albumin and blood lipids were prospectively determined in 50 pregnant grand grand multiparas (> or =9 deliveries) and 50 age-matched pregnant women with low parity (< or =3 deliveries). RESULTS The average concentrations of fibrinogen in the grand grand multiparas were 4.0+/-0.6 as compared to 4.7+/-0.7 g/l in the control group (P<0.001). In both groups D-dimer levels were >1000 ng/ml and the concentrations of albumin, triglycerides, cholesterol, high-density lipoprotein (HDL) were not significantly different. CONCLUSIONS In healthy pregnant grand grand multiparous women fibrinogen levels are lower than in age-matched women with low parity. These changes are not directly associated with lipids metabolism during pregnancy.